Darbaz Adnan, MBChB1, Ameya A. Deshmukh, BA2, Shahab R. Khan, MBBS1, Trevor Rempert1, Klodian Dhana, MD, PhD1, Mahboobeh Mahdavinia, MD, PhD1, Faraz Bishehsari, MD, PhD1; 1Rush University Medical Center, Chicago, IL; 2Midwestern University - CCOM, Downers Grove, IL
Introduction: More than seven million people have been infected globally with SARS-CoV-2 virus that causes corona virus disease 2019 (COVID-19). Besides respiratory tract, the virus can also affect the gastrointestinal tract. Data regarding the significance of GI symptoms is limited. Here, we focused to study the gap in understanding the significance of the GI symptoms at the presentation of COVID-19 in predicting the disease outcomes. Methods: We reviewed electronic encounters of 1003 patients who were tested positive for the virus between March 12th and April 3rd, 2020. Encounters were reviewed to record demographics, presenting COVID-19 symptoms, laboratory data and clinical outcomes. Patients were screened for constitutional symptoms (fever, loss of appetite, body aches), respiratory symptoms (cough, shortness of breath, smell loss, chest tightness) and GI symptoms (diarrhea, nausea/vomiting, abdominal pain) initially when they presented with COVID-19 symptoms before getting treatment for the disease. Results: Data was available in 921 (91.8%) patients. 206/921 (22.4%) of patients reported at least one GI symptom with nausea/vomiting being the most common complaint 127/206 (61.7%). Patients with GI symptoms were older, had higher BMI and had a higher prevalence of diabetes and hypertension. Patients with initial GI symptoms showed lower mean hemoglobin, calcium, albumin, and higher creatinine and AST. Additionally, patients presenting with GI symptoms showed higher admission rates to the hospital, ICU, and higher intubation rates. Discussion: Analyzing the predictive value of GI symptoms based on number of initial GI symptoms (Score 1: only one GI symptom and Score 2: two or three GI symptoms) showed a step wise increased likelihood of worsened outcomes when compared to those without GI symptoms (Score 0). GI symptoms in COVID-19 patients were present in up to 22.4% of patients and were associated with worse outcomes after adjustment for demographics, comorbidities and all other clinical symptoms. Association of GI symptoms with age, higher BMI, and hypertension is noteworthy as these factors are shown to predict worse course of COVID-19 infections. However, our analysis, adjusted for all these factors, indicates that GI symptoms are independently linked to poor outcomes. In conclusion, in this largest U.S. study to-date on the significance of gastrointestinal symptoms in COVID-19 infection, GI symptoms were independently predictive of worse outcomes.
Table 1: Gastrointestinal symptoms in COVID-19 patients at initial presentation. Data presented as n (%).
Table 2: Characteristics and outcomes of COVID-19 patients in association with gastrointestinal symptoms. Data presented as n (%), mean (SD) and median [interquartile].
Disclosures: Darbaz Adnan indicated no relevant financial relationships. Ameya Deshmukh indicated no relevant financial relationships. Shahab Khan indicated no relevant financial relationships. Trevor Rempert indicated no relevant financial relationships. Klodian Dhana indicated no relevant financial relationships. Mahboobeh Mahdavinia indicated no relevant financial relationships. Faraz Bishehsari indicated no relevant financial relationships.